A resident in an assisted-living facility is restless most nights and sits in the lounge area reading. When questioned, the resident reports suffering from insomnia. What should the nurse expect as an outcome if the resident continues with this pattern of sleep?

Safety issues with an unsupervised resident in the lounge area

Onset of cardiac dysfunction

Onset of new underdiagnosed health problems

The ability to function during the day may be hindered by these episodes.

Answer and Explanation

The Correct Answer is D

A) Safety issues with an unsupervised resident in the lounge area: While there could be safety concerns related to a resident being in a common area at night, the primary outcome expected from continued insomnia would more directly relate to the individual's functioning rather than immediate safety issues.

B) Onset of cardiac dysfunction: While chronic sleep disturbances can contribute to various health problems, including cardiovascular issues, the immediate outcome of insomnia is more likely to be seen in daily functioning rather than a direct onset of cardiac dysfunction.

C) Onset of new underdiagnosed health problems: While ongoing insomnia may exacerbate existing health issues or lead to new ones over time, the most immediate and observable outcome of insomnia would relate to how it affects daily functioning rather than the development of new health problems.

D) The ability to function during the day may be hindered by these episodes: Insomnia typically leads to increased fatigue, decreased alertness, and impaired cognitive function during the day. As a result, the resident's overall ability to engage in daily activities and interact socially may be significantly hindered by their lack of restorative sleep.

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Correct Answer is A

Explanation

A) Crepitus: This is the correct term to document the grating sound heard when a joint is moved. Crepitus can indicate issues such as the presence of air in the joint, cartilage degeneration, or other pathologies. Using this specific term provides clarity to the medical record and helps other healthcare providers understand the nature of the joint's condition.

B) Positive joint sounds: This phrase is less specific and does not adequately describe the type of sound noted during the assessment. It may also lead to ambiguity, as it lacks the medical precision that crepitus provides.

C) Grating and popping: While this description conveys what the nurse observed, it is not a standardized medical term. Precise documentation is essential in medical records, and using non-standard language can lead to confusion.

D) Crackles: Typically associated with respiratory assessments, crackles refer to sounds heard in the lungs and are not applicable to joint examinations. Therefore, this term would be inappropriate for documenting findings related to joint movement.

A. Information sharing is limited to those directly involved in the client's care. B. All members of the units healthcare team may have access to the client's chart. C. The Health Insurance Portability and Accountability Act (HIPAA) determines who may communicate with the client. D. The medical records are open to any hospital employee, including administration.

Correct Answer is A

Explanation

A) Information sharing is limited to those directly involved in the client's care: This statement reflects the principle of confidentiality and the ethical obligation to protect the client's private health information. Only healthcare providers directly involved in the client’s care should have access to their information, ensuring that it remains secure and confidential.

B) All members of the unit's healthcare team may have access to the client's chart: While many healthcare team members need access to the client's information for care coordination, this statement is misleading. Access should be limited to those directly involved in the client’s care to protect their confidentiality.

C) The Health Insurance Portability and Accountability Act (HIPAA) determines who may communicate with the client: While HIPAA does set guidelines for the protection of health information and governs the sharing of health data, it does not specifically determine who may communicate with the client. Instead, it focuses on protecting their privacy.

D) The medical records are open to any hospital employee, including administration: This statement is incorrect as it violates confidentiality principles. Medical records are not accessible to all hospital employees; access is restricted to authorized personnel only, ensuring that patient information is kept confidential.

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A resident in an assisted-living facility is restless most nights and sits in the lounge area reading. When questioned, the resident reports suffering from insomnia. What should the nurse expect as an outcome if the resident continues with this pattern of sleep?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse assesses a client and finds that a grating sound is present when a joint is bent and straightened. Which term will the nurse use when documenting this finding in the medical record?

Correct Answer is A

Explanation

The nurse is admitting a client to the acute care unit. Which should the nurse consider when regarding the confidentiality of the client?

Correct Answer is A

Explanation

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